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ARUP Laboratories’ First Annual Winter Update in
Clinical and Laboratory Medicine is scheduled for March 3-7, 2008 at The
Canyons, in Park City, Utah.

This 22.5
hour review and update in the areas of clinical chemistry, immunology,
microbiology, and molecular medicine is intended to improve knowledge about the
pathogenesis and clinical manifestations of a wide variety of metabolic
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We thank Dr. Julia Braza, Beth Israel Deaconess Medical Center, Boston, Massachusetts (USA), for contributing this
case. To contribute a Case of the Week, email [email protected]
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Case of the Week #108

Clinical
History

An 86 year old woman had neck pain
and difficulty swallowing. A CT scan (figure
1-arrow) showed a nodular enhancing mass in the left hypopharynx
at the level of the glottis / subglottis, obscuring the left pyriform sinus.
The interpretation was possible pharyngeal neoplasm such as squamous cell
carcinoma, with infection less likely.

The biopsied material consists
primarily of parathyroid chief cells and adipose tissue, with a thin fibrous
capsule dividing the cells into lobules. There is also a focus of adjacent
mucinous glands, and a separate fragment of squamous epithelium overlying
skeletal muscle.

Immunostains were: cytokeratin
cocktail; chromogranin;
synaptophysin;
parathyroid
hormone(the parathyroid glands are on the upper left hand side,
the mucinous glands are on the lower right hand side). These findings are
consistent with parathyroid tissue. No definite evidence of parathyroid
hyperplasia or adenoma was identified.

The serum PTH level was within
normal limits, and the surgeon indicated that the entire mass had been
excised. Thus, the precise cause of the patient’s new onset pain and
difficulty swallowing is unclear.